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Monday, March 19, 2007

(HealthDay News) -- Eight of 10 Americans age 65 or older are living with heart disease, diabetes or some other form of chronic illness, according to a new report by the U.S. Centers for Disease Control and Prevention (CDC).

The State of Aging and Health in America 2007 was released Thursday and includes up-to-date information on 15 key health indicators for older adults.

"We are really interested in healthy aging and in ways we can promote healthy aging even in the presence of chronic diseases," said Lynda Anderson, chief of the CDC's Health Care and Aging Studies Branch.

The report is also a report card on how the states measure up to the national goals established in Healthy People 2010, Anderson noted.

The number of Americans 65 and older is estimated to reach 71 million by 2030, about 20 percent of the population. By that time, U.S. health care spending is estimated to increase by 25 percent because of an aging population, according to the report.

The report looks at seniors' "health status" -- the number of physically unhealthy days seniors experience, their frequency of mental distress, their oral health and levels of physical disability. There is also an evaluation of health behaviors, such as physical inactivity, nutrition, obesity and smoking.

The study also assesses preventive care and screening. These factors include flu vaccine, pneumonia vaccine, mammography, colorectal cancer screening, preventive screening, and cholesterol levels. In addition, injuries such a hip fracture hospitalizations are also evaluated.

"The good news is that, at the national level, we are actually meeting some of the [government's] Healthy People 2010 targets," Anderson said. For example, national goals are being met in mammograms, colorectal cancer screening, cholesterol testing and the reduction in the number of smokers, she said. "Only 9 percent of older adults are smoking," she added. In addition, 21 states and the District of Columbia have met targets on oral health.

However, no state has met the target for physical activity, eating fruits and vegetables daily, and flu and pneumonia vaccines, and only three states -- Colorado, Hawaii, and New Mexico -- have met the target for lowering obesity.

In addition, more progress is needed in making sure older Americans get flu and pneumonia vaccinations. There also needs to be an effort to reduce hospitalizations for hip fractures, particularly among women, according to the report.

In terms of individual states, Minnesota, Oregon, California, Hawaii and Washington are doing the best in meeting national health care goals, Anderson said. Those at the bottom of the list include Mississippi, Georgia, and other southeastern states, she noted.

Anderson also said that one of the areas that is lagging behind in most places is physical activity. Older adults simply aren't getting enough, Anderson said. "If we can point to a critical area where people can benefit, it is physical activity," she said. "Physical activity can prevent functional decline, falls, and it may even improve cognitive health," she said.

The hidden threat to senior health is the epidemic of obesity, Anderson said. "Obesity can undermine all the other good things that are happening," she said.

Factors like obesity may be taking their toll: 80 percent of older Americans suffer from one chronic disease, and a full half of seniors are burdened by two chronic illnesses, the CDC report found.

One expert is concerned that while some goals are being met, others that are more difficult to achieve are not being addressed.

"It's a great achievement that we have identified areas to focus on and are measuring our progress toward achieving those goals," said Dr. Mike Steinman, an assistant professor of geriatrics at the University of California, San Francisco.

Steinman said the easier goals -- such as mammography and colorectal cancer screening -- have been achieved. "However, a lot of the more complex efforts, for example, preventing obesity, increasing people's fruit and vegetable intake and helping to maintain oral health, are not being met," he said.

Health is not just going down a list and checking off boxes, Steinman said. "There are a lot of more complex series of behaviors and interventions that can be much harder to measure but probably have a lot more impact on people's quality of life," he said.

Steinman believes that physicians are too often focusing on items they can quickly check off during an office visit. They may be too pressed by time and money concerns to deal with other aspects of a patient's life, such as diet and exercise.

"If doctor's pay is being based in part on their performing according to these checklists, and if their quality is being measured by these checklists, there is an incentive for them to do those things on the list, even at the exclusion of other things which may not be on the list but may be more important." Steinman said.

Anderson agrees that doctors alone can't hope to deal with implementing all the health recommendations older people need. "For example, we want to have the physician tell people they need to get physical activity, and then the community needs to help link people with the ways people can do that," she said.

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